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The failings locally were recorded in October for the most time-critical Red One category, covering patients not breathing or with no pulse due to cardiac arrest or other severe conditions.

Ministers insist they must get a response within eight minutes of the call in at least 75 per cent of cases.

But latest figures showed they plunged to 54.5 per cent last October, taking the average for the year until then to 83.8 per cent. In more built-up Stoke-on-Trent, 92.3 per cent of calls had a response within eight minutes during the same month.

Ambulance bosses blamed the failing on 999 calls being made from 'challenging outlying rural areas.' It is unclear what happened to the 10 patients.

The data was issued by North Staffordshire NHS funding body the clinical commissioning group (CCG) whose leaders said they were not considering imposing penalties.

Instead they are to raise the issue with WMAS at their next joint meeting.

Leek GP Dr David Hughes, CCG chief officer, said: "These are very small numbers as there were only 22 calls in this category during the month.

"It looks like a really odd blip as for every other month performance is well above the standard.

"But as we cannot explain it we will watch it closely and I will raise it at the next meeting of the ambulance commissioning board which I chair."

A WMAS spokesman said: "This figure was the lowest of the year and reflected a higher than average number of calls to some challenging outlying rural areas.

"The current year-to-date figure for Red One calls within North Staffordshire CCG is 80 per cent."

The former Staffordshire ambulance service was merged into the West Midlands trust seven years ago.

Campaigner Ian Syme, of North Staffordshire Healthwatch, said: "This is a clear deterioration of standards. It may only be a small number of patients but for the 10 people involved it is significant.

"It is the worst record I have seen in 17 years of following the service.

"We are not getting the same service clinically from the West Midlands that we did from Staffordshire.

"The trust is performance-monitored by Dudley and Sandwell CCG on behalf of the whole region but we say the local operation should be monitored by the Staffordshire CCGs."

WMAS chief executive Anthony Marsh was awarded the Queen's Ambulance Service Medal in the New Year's Honours.

He is to spend four days a week on secondment at the troubled East of England Ambulance Service Trust.